The gluten question

Who doesn't love a warm cookie or pizza? Unfortunately, gluten—an elastic protein that gives a chewy texture to wheat, rye, barley, and some oats—causes digestive distress for a lot of people. In my own family, "gluten intolerance" meant a burned bottom and vomiting for my young son, and constant stomachaches and, well, socially embarrassing consequences for me. No clear tests identified our intolerance, but once we removed gluten from our diets we miraculously felt better. If you suspect a gluten problem for yourself or a family member, here's the information you need.

Intolerance versus celiac
Gluten reactions vary wildly, making diagnosis a challenge. Effects often seem unrelated; symptoms can show up as constipation or diarrhea, as well as fatigue, skin rashes, bloating, grumpiness, and joint or bone pain, among other symptoms. Manifestations can be immediate or may not appear for up to 48 hours, and may be completely different, even among family members. And, while an adverse reaction could merely mean intolerance, it could also signal celiac disease (also called gluten-sensitive enteropathy and celiac sprue), a serious hereditary autoimmune condition that damages the small intestines. Detected through blood tests and confirmed by biopsies (the tests aren't perfect, but they are improving), celiac disease means that a person can never eat gluten safely.

Nobody even has a guess as to how many people are gluten intolerant and don't know it, but in the United States, 1 in 133 people is known to have celiac disease (the prevalence among close relatives is 1 in 22). In addition, 30 percent of people worldwide are genetically predisposed to the disease, three percent of whom could develop it, says Mary Schluckebier, executive director of the Celiac Sprue Association. Although researchers aren't sure why, the onset of celiac disease in someone predisposed may be triggered by any number of factors, including the large amount of gluten in the typical diet, emotional stress, pregnancy, or viral infection. Some theories also point to how long a person was breastfed as an infant and the age at which gluten was first introduced to the diet.

Because this frustrating condition typically takes a decade or so to identify, unrecognized celiac-disease symptoms can lead to compromised immunity and misdiagnoses. Years of nutrient malabsorption can cause nutritional fallout, such as failure to thrive and stunted growth in children, and numerous immune-related side effects at any age. Fortunately, healing for intolerance and celiac starts by simply cutting out dietary gluten—an easier prospect than ever before, given increased public awareness.

Avoid genetically modified foods. In Europe, recent studies partially attribute the increase in food allergies to the consumption of genetically modified organisms (GMOs). Check labels for "GMO-free," and watch out for foods containing the most common GMO crops, corn and soy.

Use probiotics. When my son was a baby, probiotic tablets helped stop his constant diarrhea. These beneficial bacteria exist in cultured foods, such as yogurt, miso, and kombucha, as well as in supplements. Essential for intestinal health, they're especially helpful for those with gluten issues.

Take a multivitamin. Gluten reactions can cause intestines to be less efficient in absorbing vitamins, so a good multi is smart insurance.

Drink green. People with celiac disease are highly prone to vitamin K deficiency, a nutrient that's responsible for blood clotting, among other things. In addition, gluten intolerance and celiac disease often cause inflamed bowels. Alfalfa tea and green tea provide both vitamin K and helpful anti-inflammatory agents. (If you are on blood thinners, check with your health care provider.)

Lifestyle

Get tested. Given celiac disease's hereditary nature, all family members should get tested when one member receives a diagnosis. If you are "just" gluten intolerant (not celiac), tests probably won't diagnose it. But try going gluten free to determine if that helps reduce unexplained discomforts, including daily stomachaches, exhaustion, or gas.

Become a label sleuth. The challenge of gluten-free living is magnified by gluten's ubiquity. "It's the second most common ingredient in all the foods you're going to eat," says Alice Bast, founder of the National Foundation for Celiac Awareness. New food-labeling laws make gluten identification easier, but some products, including medications, may still contain grain derivatives; red-flag words include starch, stabilizer, flavoring, hydrolyzed plant protein (unless it's made from corn or soy), or emulsifier.

Be prepared. Staying away from gluten can be tough, especially for kids. Birthday cakes at school parties, cookies at a friend's house, crackers as playdate snacks: Gluten pitfalls abound. To reduce temptations, carry gluten-free options to gatherings, and keep a stock of special items in your child's classroom. Freeze wheat-free cupcakes and send several with your child to share during celebratory gatherings (sharing also reduces the social isolation children experience with gluten intolerance).

Watch for changes. A body's response to gluten intolerance can change. When my son was in preschool, a cracker would induce vomiting. Now he can enjoy a "real" (made with wheat) piece of pizza without discernable downsides. Sometimes, though, the changes go the opposite direction, and symptoms worsen.